ORIGINAL SCIENTIFIC REPORT Is Ischemia-Modified Albumin a Reliable Marker in Accurate Diagnosis of Appendicitis in Children? Emel Ulusoy 1 • Hale C ¸ itlenbik 1 • Fatma Akgu ¨l 1 • Ali O ¨ ztu ¨rk 1 • Nihan S ¸ ık 1 • Oktay Ulusoy 2 • Tuncay Ku ¨me 3 • Durgu ¨l Yılmaz 1 • Murat Duman 1 Ó Socie ´te ´ Internationale de Chirurgie 2019 Abstract Background Acute appendicitis is one of the most common abdominal emergencies. Despite all improvements in diagnostic techniques, there are still ongoing problems as proper diagnosis, misdiagnosis and perforated appendicitis. The aim of this study is to demonstrate the clinical value of IMA in patients with appendicitis and to determine the accurate diagnosis of appendicitis in clinically suspected patients. Methods Pediatric patients with acute abdominal pain who had the Pediatric Appendicitis Score (PAS) C 7 (n = 109) and a control group of 35 patients were included in this prospective case–control study. Patients were divided into two groups: patients with appendicitis (pathologically confirmed) (n = 78) and no appendicitis (n = 31). No appendicitis included observation patients and negative appendectomy. Serum samples were collected for routine laboratory parameters and IMA before surgery. Results Patients with appendicitis had significantly higher IMA levels than no appendicitis and control groups (p = 0.001 and p \ 0.001; respectively). Moreover, patients with negative appendectomy had significantly lower IMA levels than patients with appendicitis (p = 0.009). IMA and PAS were used together, and in the ROC analysis, we obtained 0.81 AUC for PAS and 0.89 AUC for PAS and IMA. Conclusion The current study indicated that IMA is a reliable marker for accurate diagnosis of appendicitis. The combination of IMA with PAS score has been shown to facilitate the diagnosis of appendicitis. Introduction Acute appendicitis (AA) is a common cause of surgical emergencies in childhood and should be urgently differed from nonspecific acute abdominal pain. The absence of classical clinical findings is neither sensitive nor specific for excluding appendicitis [1, 2]. However, laboratory and radiological methods are commonly used to provide addi- tional information in decision making, and they are non- specific because many other diseases may mimic appendicitis [3–5]. Although all these parameters are nonspecific one by one when evaluated together, it has been found to facilitate the diagnosis and several clinical scoring systems have been devised [6–8]. The aim of all these diagnostic tools is to reduce negative appendectomy. Therefore, the clinicians still need an objective parameter for accurate diagnosis. Ischemia-modified albumin (IMA) has become a prominent molecule in recent years regarding the role of ischemia in the pathophysiology of appendicitis. & Murat Duman mduman@deu.edu.tr 1 Department of Pediatrics, Division of Pediatric Emergency Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey 2 Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey 3 Department of Biochemistry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey 123 World J Surg https://doi.org/10.1007/s00268-019-05323-1